Expert Discusses How The COVID-19 Pandemic Changed The Pharmacy Profession

In a Pharmacy Times® interview, David Zgarrick, PhD, FAPhA, professor in the department of pharmacy and health systems sciences at Northeastern University, discussed how the COVID-19 pandemic has changed pharmacists and pharmacies and what that means going forward.

He addressed the 3 most impactful and lasting changes, how pharmacy technician's roles have chnages, and what can be expected for the pharmacy profession in the next few years.

Ashley Gallagher: Hi, I'm Ashley Gallagher from pharmacy times, and today I'm speaking with David Zgarrick professor in the Department of Pharmacy and Health Systems Sciences at Northeastern University, about how the COVID-19 pandemic has changed pharmacists and pharmacies and what this could mean going forward.

The COVID-19 pandemic has impacted the way pharmacy staff and pharmacies in general operate. What are 3 of the most impactful and lasting changes you have seen in the pharmacy profession?

David Zgarrick: Thank you so much, Ashley. It's so nice to meet you, and so nice to have a chance to speak with your viewers today. 3 things that I look to in terms of changes in the pharmacy profession that are coming forward as a result of COVID.

First and foremost is that immunizations and vaccinations no longer are peripheral to dispensing prescriptions and other aspects of the community pharmacy business model. They now have become a central part of that business model and must be planned for accordingly, including things like pharmacy design, personnel, financial marketing, everything that we do now includes immunizations and vaccinations as part of that business model.

The second is the rise of telehealth and telepharmacy. We now recognize that remote work, whether by pharmacy personnel or by our patients themselves, will be an important part of community pharmacy practice moving forward.

The third aspect is that patients health care providers and communities look to pharmacies not only as sources of medications, but also as important health resource centers for information. pharmacies will continue to be the most accessible point of health care in the United States.

Ashley Gallagher: As pharmacists take on more clinical roles, what changes within pharmacies will need to be made?

David Zgarrick: First and foremost, I think one of the biggest changes that will have to occur in pharmacies is our information management systems. Just simply how is it that we capture the clinical interventions that we are making on behalf of our patients and what interventions or what outcomes those interventions will actually have?

That means that information is needed and the data is going to need be evaluated from those from what we gather, in order to be able to help continue our value proposition. Pharmacists, as they go into more clinical roles will certainly need to be able to show what value those clinical roles bring to patients and bring to those paying for care, and it's important that we have information systems in place that will help us be able to document and solidify that value proposition.

Ashley Gallagher: Pharmacy technicians have also seen a growth in their roles, such as administering vaccines. Moving forward, how will the roles continue to expand?

David Zgarrick: I think it's fair to say that as pharmacy technicians grow in their capabilities, and as pharmacies look to support from other personnel in order to enable them to practice both at the top of their license, as well as to manage the financial aspects of a pharmacy practice, we're going to continue to look more and more to pharmacy technicians.

On one hand, it's fair to say that pharmacy technicians roles simply certainly will be continued to expand in the future. I do think a important caveat to that, though, is that technicians are now going to need to be paid consummate with the level of expectations and responsibilities that they have that they're taking on.

We simply cannot ask technicians to do the types of roles that pharmacists have traditionally done and continue to pay them at a level that pharmacy technicians need to get paid. If we want to expect more from pharmacy technicians, pharmacies are going to have to figure out how are they going to pay pharmacy technicians at a level that is consonant with their responsibilities.

Ashley Gallagher: How have patient expectations changed since the pandemic began? And how can pharmacists best meet those expectations?

David Zgarrick: Patients still continued to seek answers for their health. And probably 1 of the things that has happened as a result of that pandemic, is there is so much more health information that is out there and available and it comes from a variety of sources.

As we all know not all of this health information that patients receive is good information and and 1 of the things that we as pharmacists can do to help patients meet those expectations is to help our patients learn how to be critical of evaluators and consumers of healthcare information just like we as pharmacists, you know, critically evaluate the drug literature and the information that we have to help us make decisions about patient care.

We can take steps that help our patients better use and better sift through all the information that they have as well. And I think that's a very, very important role that we can do is is really, you know, the public looks to pharmacists, because we are so accessible as a source of information to be able to help them make sense of everything that they're seeing and hearing.

Ashley Gallagher: With the addition of more roles for pharmacists and pharmacy technicians, how is burnout being addressed?

David Zgarrick: Burnout is a very important issue in pharmacy right now. I know recently, there was a American Pharmacists Association just sponsored a summit that addressed the burnout of pharmacists and pharmacy personnel.

I'm very active. I'm on the board of directors of the American Association of Colleges of pharmacy and 1 of our tenants of our new strategic plan is the health and wellness of all people in essence, the the pharmacy arena, everyone from student pharmacists, to pharmacy professors, to the clinicians and practitioners that we work with being paying more attention to health and wellness, which goes beyond just simply saying, 'Yes, I understand it's an issue or here's a free slice of pizza.'

It really means, you know, paying heed to the issues and being able to address them in a very meaningful way. And that can be what are we doing to support our personnel on a personal level, including enabling them, the time and the space to get the help and the resources that they need so that they can continue to provide the high quality care that we depend on them.

The ability to be able to provide support personnel so that when people do take a step back, that, that their role, in essence isn't being missed that somebody else can step in and do the job that those people otherwise would. Sometimes we as pharmacists can be our own worst enemy, because we may need the time to be able to address our own personal health.

Yet, we also recognize that if we aren't there in those patient care roles, it's very difficult to imagine who else will be there. So again, it's important that pharmacies and pharmacists work together to make sure that we have ample amounts of trained personnel and then also that even things like regulations and other things that can limit the capabilities of pharmacists and give limit where and how pharmacy personnel can work. Some of those things need to be addressed so that we can provide more resources to the pharmacy personnel that need them.

Ashley Gallagher: How has telehealth proven to be an effective tool for the pharmacy profession? And how has it helped to alleviate some stress from pharmacists?

David Zgarrick: Telehealth has certainly proven to be essential as we have navigated through the pandemic. First and foremost, it provided a safe way for our patients, as well our personnel to be able to interact with each other, particularly when we didn't have the protections of the vaccine and what we know about how to most effectively deal with the virus.

As time went on, there was likely less need for the safety and protection that telehealth provided and more people just simply recognize the convenience that telehealth provides and continues to provide, you know, particularly patients who have busy lives are able to interact with pharmacy personnel in ways that do not mean that they have to come physically to the pharmacy in order to be able to get the help and the information that they need.

Telehealth in some ways has alleviated some stress on pharmacists and has enable us to be able to interact with patients in ways that we hadn't been able to interact with before. And other ways it might be fair to say that it has created some stress for pharmacists for 1 telehealth is something, is a form of technology that many pharmacy personnel have had to learn. You know, we have to learn how to make the most effective use of telehealth and that has taken some time and effort.

Another thing as far as telehealth goes, is that we have to make sure that it's available to all pharmacists where they need it when they need it. It does sometimes mean that pharmacists feel like they're taking their work home with them and that, in turn, can create some more stress.

One of the great potentials for telehealth is it can help address what we might call some of the, you know, geographic misappropriation, so to speak of pharmacy personnel. We don't necessarily have a shortage of pharmacists today, or pharmacy personnel, but they're not always in the places where we need them to be, or especially where patients need to have the assistance from pharmacy personnel. And so telehealth certainly provides a platform upon which we can provide services to our patients without the geographic barriers that we've traditionally had.

One potential barrier that we do have to address as we move forward with this is some of the legal and regulatory barriers. The barriers that state that we as a pharmacist, of course, have to be licensed to be able to provide care to patients typically based on what state they are living in and where we are providing those services.

What we're going to be seeing is the need for our health regulators, particularly our Boards of Pharmacy, to work together to see how we can address the need, of course to have safe and effective and regulated health care professionals providing services across geographic barriers and across geographic boundaries that are traditionally defined, where one has a pharmacy license.

Ashley Gallagher: What can we expect for the future of pharmacy as a profession in the next few years?

David Zgarrick: I continue to be optimistic for the future of our profession if for no other reason that patients continue to need medications and pharmacists continue to be the experts with regards to medication use, and so long as we can continue to use our knowledge, our information, our experience, to help patients achieve desired outcomes with their medications. They're certainly going to be a good place for pharmacists.

What I see evolving and changing over time is just simply the fact that it's not going to be in anyone's best interest to have a pharmacist focus their time and efforts and energy on tasks like dispensing. That's not to say dispensing isn't an important and essential issue. It's just that there are other people and other technologies that can more effectively do those those dispensing duties.

Pharmacists, on the other hand will be focusing their efforts on helping others get the best value for their medications. One of the things that's, interestingly enough, as we see medications getting more and more expensive, and we certainly see that within certain categories and classes of drugs. This actually presents more opportunities for pharmacists to be able to step in and make sure that those drugs are being used safely and effectively.

We can see almost an instant return on the pharmacists investment of their time, just simply by alleviating the misuse of very expensive drugs and to helping ensure patients get the desired outcomes with respect to using the most effective, most expensive drugs.

Somebody much wiser than me once said, 'if you want to know where the answers are, follow the money.' And I say that from a pharmacies perspective, not so much in a way that following the money is the way to fame and riches in pharmacy so to speak, but following the money is the way that we can increase our value to our patients and to other health care providers and just society as large as we as pharmacists, you know, understand, you know, where the most expensive medications are being used and what medications are the most likely to impact the quality of life and expenses that our patients and society bear the better we understand that the better we will be able to interact and intervene on behalf of our patients.